In the 1960s, the Brazilian government adopted a laissez-faire attitude, which lead to the predominance of private organizations in the provision of family planning services. Since then, Brazil has witnessed one of the most dramatic reductions in family size in modern history in part due to increased access to family planning services.

However, in early 2015, the widespread epidemic of the Zika fever caused by the Zika virus in Brazil caused persisting gaps in access to contraception to resurface. Since it was first detected it has instilled fear and uncertainty in pregnant women whose fetuses could be at risk of Zika-related birth defects like microcephaly should the virus be contracted during pregnancy. This makes access to comprehensive reproductive health services and education a critical need for women who are pregnant or considering becoming pregnant.

While contraceptive use is fairly high in Brazil with 75.2% of women using modern forms of contraception, barriers to access remain. Some women face challenges, some of which include but are not limited to incomplete insurance coverage or lack of reimbursement for long-acting reversible contraceptives (LARCs), high up-front costs, low number of contraceptive service sites, and/or a lack of supply of the implants in the public sector . This may be one driver behind why LARCs only make up 0.5% of all contraceptive sales. Furthermore, 55% of all pregnancies in Brazil estimated to be unplanned and 20% of all lives births are attributed to teenage girls, indicating that there may be substantial reproductive knowledge gaps in how to effectively prevent pregnancy.

Amid the spread of a virus that poses unique health risks to pregnant women and their fetuses, there is an urgent need to address these gaps in reproductive health access and education. First, the Brazilian National Health System, which laudably provides most contraceptives free of charge to about 74% of the population, needs to reevaluate existing policies that may be still limiting access to contraceptive services. Secondly, organizations like the Brazilian Society for Family Welfare (BENFAM), which provides reproductive health services and education to underserved Brazilian communities, need greater financial and political support from policymakers, civil society, and even organizations traditionally opposed to such services like the Catholic Archdiocese.

Despite Brazil’s great strides to improve access to contraception and reproductive health education in recent years, Zika’s arrival highlighted gaps in the existing system that must be addressed through policy reform and greater political and financial support. Especially in the time of Zika, Brazilian women deserve no less.

This is a very interesting post. It incredible how a rise in infection can reveal other public health issues.

I am sure their stigma associated with accessing contraceptives amongst Brazilian women. Are there any government programs addressing the stigma? If so, how?

Also, are the sexual health programs widely accessible for all areas and all ages? Do they introduce several acceptable types of contraceptives? Are there are institutionalized sexual health programs such as in schools?

As you point out, access to reproductive health services in Zika-endemic areas is critical for women who are pregnant or considering becoming pregnant, but then you used limited access to LARCs as an example of an unmet need for these women. However, Zika can be spread from all sexual contact between partners, including oral sex and the sharing of sex toys. The WHO and CDC currently recommend that women who are pregnant should either abstain from sex for the entire duration of pregnancy or use condoms and dental dams for all sexual contact. Other forms of contraception, such as LARCs, would not prevent the spread of Zika to pregnant women. Additionally, we don’t really know how long a person can spread Zika, so current recommendations are for men who have been in areas with Zika to use condoms for at least 6 months.

Do you know why there is such a discrepancy between the high use of modern contraceptives and the high percentage of unplanned pregnancies? Is there a way to identify and target this population that is having the unplanned pregnancies for more aggressive reproductive health interventions? Additionally, are there plans to target high-risk areas in Brazil, such as favelas?

This is a great perspective! I agree with your point that there could be a silver lining to the Zika epidemic if it brings back to the forefront discussions about access to contraceptives and reproductive health information. This could end up being an effective “window of opportunity” for family planning advocacy in Brazil. The advocacy process may be more successful if it is focused on those with the highest need and identifying that subgroup may be an important starting point. A targeted effort may be even more crucial in Brazil given the widespread access and use of contraceptives among Brazilian women. As you point out, this comes in sharp contrast with the number of unplanned pregnancies in the country. It seems that adolescent and young adults are those who are facing particular barriers to access family planning in Brazil and suffering most from unplanned pregnancies (goo.gl/nFAIhD). Efforts to expand contraceptive and reproductive health services may want to target these pockets of high unmet need for family planning in order to capitalize on the “Zika window”.

[…] Health Care.” We often share blog posts that relate to tropical health issues. Below is a posting by class members Linda Cho, Linda Chyr, Rebecca Earnest, and Sarah Rosenberg on Zika, family planning, and […]

This is an interesting post, thank you for your research. Indeed, the Zika epidemic ends up being an “entry point”, or it highlights, many other public health issues in Brazil. First of all, the direct relation to the lack of care toward these women affected by the Zika virus. All throughout the country, the women that have microcephalic babies don’t have the information or care they would need. On the other hand, there’s the incredible amount of young age women that do get pregnant. There really isn’t a nation wide program to prevent young pregnancy and even the NGO’s and programs that do focus on that are faced with religious or economic and social issues and do not develop a long term strategy. This raises another issue though, since a recent research has shown that “more than half of Brazilian women in reproductive age are giving up getting pregnant because of Zika virus” (http://g1.globo.com/bemestar/noticia/mais-de-50-das-brasileiras-desistem-de-engravidar-por-causa-do-zika-diz-pesquisa.ghtml), which is related to what you posted because it will raise the question of wether or not the government is ready to deal with the issue of adequately addressing contraceptive distribution for the population.